Antenatal screening and prevalence of infection: surveillance in London, 2000-2007

In the United Kingdom (UK), it is recommended to universally offer antenatal infection screening for human immunodeficiency virus (HIV), hepatitis B and syphilis infections, and susceptibility to rubella for the benefit of the mother and to reduce vertical transmission of infection. This paper describes the surveillance of antenatal infection including uptake of screening, and the results of testing in pregnant women in London between 2000 and 2007. Antenatal screening coordinators in liaison with midwifery heads and microbiologists at all thirty London National Health Service (NHS) Trust maternity units supplied quarterly data on the number of pregnant women booked for antenatal care, tests done, and tests results. The overall estimated uptake of screening increased since 2000 and reached 95.6% for HIV, 96.5% for syphilis, 96.2% for hepatitis B and 97% for rubella susceptibility by the second half of 2007. There is considerable variation in the performance between NHS Trusts. The overall estimated prevalence of HIV infection was 3.4/1,000 women (ranging from <1/1,000 to 10/1,000 across Trusts), of hepatitis B (HBsAg-positive) was 11.3/1,000 (2.6/1,000- 23.9/1,000), of syphilis was 4.4/1,000 (<1/1,000-16.3/1,000) and of rubella susceptibility was 39.3/1,000 (19-103/1,000). Antenatal infection screening has improved and there has been some success in implementation of national policy. However, screening uptake and prevalence of infection vary considerably across London NHS Trusts and some women are evidently disadvantaged. Improvements in information systems should help local partners to focus their interventions in those Trusts where work is still needed to increase testing as well as the capacity to monitor the uptake of screening.